24 04 2023
As per official data from the International Agency for Research on Cancer, almost 500,000 individuals die every year due to pancreatic cancer (further details on epidemiological characteristics are available in the diseases and procedures section). Regrettably, the tumour is usually identified in the advanced stage when patients begin to experience the first signs of discomfort or illness.
Advanced pancreatic cancer is a tumour that is closely associated with significant venous or arterial blood vessels surrounding the pancreas or a tumour that has spread to other organs, primarily the liver. The disease’s stage is determined using radiological methods for visualization. In the case of pancreatic cancer, the preferred diagnostic technique is CT scanning. If surgery is used as the sole form of treatment for advanced disease, the results of surgical treatment are unremarkable. Multimodality therapy offers the best chance for optimal survival after pancreatic cancer treatment.
Neoadjuvant therapy has become the standard for treating advanced pancreatic cancers. A complete neoadjuvant treatment, which involves administering oncology therapy in its entirety before surgery, without dividing it into preoperative and postoperative (adjuvant) therapy, is increasingly being used worldwide. Preoperative chemotherapy can be administered after pancreatic tumour biopsy and histopathological confirmation of the diagnosis. Tissue samples can be obtained during the endoscopic ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), or percutaneous biopsy. These procedures are performed by a gastroenterologist-endoscopist or an interventional radiologist under ultrasound or scanner control. Obstructive jaundice is a common condition among patients, and biliary stent placement is necessary to establish bile flow and alleviate jaundice, which can hinder the application of cytostatics before surgery. Neoadjuvant therapy is standard practice for marginally resectable and locally advanced tumours, and more and more centres around the world are using preoperative therapy for smaller, initially resectable tumours. The modified FOLFIRINOX regimen, which includes several cytostatics, is the global standard (Fluorouracil Leucovorin, Oxaliplatin and Irinotecan). An alternative treatment is the drug Gemcitabine, as monotherapy or in combination with Capecitabine or Paclitaxel.
Currently, intraoperative radiotherapy is controversial and is only applied by a few centres around the world. Targeted therapy with monoclonal antibodies is only used in clinical research, but certain subtypes of cancer show sensitivity to this type of modern therapy.
In cases where metastatic pancreatic cancer is diagnosed, the initial therapy consists of either the modified FOLFIRINOX regimen or the Gemcitabine/Paclitaxel regimen. The efficacy of surgical treatment for metastatic disease is uncertain, but it may be considered if there are only a few metastases, and the disease is stable after the application of strong chemotherapy.
